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House holds the key on private option

The problem was always going to be the House of Representatives.

The shrewdest technicians of the Republican majorities in both chambers engineered an end-around of a simple expansion of the Medicaid program. They compelled Gov. Beebe, already convinced, to convince Washington to accept their terms, take it or leave it, as the cost of doing business politically, philosophically, fiscally. Even clinically. At issue was health insurance for a quarter-million Arkansans without it, whose flus, coronaries, broken limbs and endangered pregnancies were being paid for in the higher premiums charged Arkansans with coverage, the balance retired by the taxpayer at large.

Thus were institutional providers, especially, at pains to emphasize how crucial to their budgets, even their survival, was some source of additional revenue. Rejecting billions in federal dollars? What were they thinking?

The larger corporate community had to sign on. Finally, it did, comforted that any invasion of its precincts would be held to a minimum and its profit margins probably enhanced, and with scores of millions in tax cuts for its most affluent corporations and individuals to salve any concerns about federal deficit and debt. The reductions for upper-income filers, especially those with capital gains itching to be realized, were implicit, always, in the negotiations and acknowledged, now, in the scramble for votes. A bargain, yes, in the transactional sense; how grand a bargain depends on one’s portfolio, assuming the existence thereof.

Still, there would have to be some baubles for the extra-chromosome Republicans including the sizeable Tea Party contingent, confident of an entitlement quite apart from the programs they disdain. A mindset that forever has demanded a rooting out of “waste, fraud and abuse” in social programs; a perpetual outrage almost invariably styled to suggest that the outraged do not recognize where the big money in “WFA” is made, or stolen. So, a new Medicaid Police? Scan cards? (Sub-dermal computer chips?) Drug testing?

Altogether it was enough to move the Senate over the first hurdle, the architecture of the private health insurance exchange. Eighteen votes were required, the bill won 24. The money shot — the appropriation — would need three more to reach the necessary three-quarters majority. Given the distance traveled it seems achievable, although six of the 11 Republican senators who either opposed the expansion authorization or did not vote must stand for re-election next year, making the sale something less than a cinch.

The House, though — a different animal. Much more cantankerous than usual, skeptical of received wisdom, contemptuous of conventional wisdom. A one-vote GOP majority as opposed to the Senate Republicans’ 21-14 Republican grasp, and led by a Speaker of their party who was installed by Democrats. Everyone save the term-limited runs again next year, exposing three dozen Republicans — a third of the chamber’s total membership — to potential savagery in the coming primaries. Many of the sitting Republicans, especially those from previously Democratic districts, were swept into office in the anti-Obama waves of 2010 and 2012, and theirs is to choose between the rhetoric of their own previous campaigns and the reasoning of their leaders.

Make that, some of their leaders. Speaker Davy Carter and Chairman John Burris (R-Harrison) pushed the substantive portion of the health exchange bill free of the House Public Health Committee at mid-week on a voice vote, though not before Rep. Bruce Westerman, the House GOP leader, removed himself as a co-sponsor. Westerman had never put his shoulder behind the bill, but his repudiation of it signaled continuing Tea Party resistance.

Worth noting: At least a couple of House Democrats are as worried about their starboard flank as their wavering Republican counterparts. Others are dismayed that the compromise between the GOP’s legislative brain trust and Mr. Beebe betrays the promise of Obamacare, but they have nowhere else to turn.

Only 51 votes are needed in the House to push the structure of the private option over the top and success on that score is all but assured. Twenty-four others will be needed to fund the program — the money shot — and at this writing the necessary supermajority is a moving target.

In winning the General Assembly, the Republican majority won the opportunity to shape public policy as it had not since Reconstruction. But it also won the responsibility of governing, in tandem with the executive of another party. Failure is an option.